News Bureau
Revitalizing Family Planning in Mali
An innovative initiative to increase the use of family planning services provided by the Malian army has taken off: the pilot project reached 1,000 civilian and military families in five months and attracted several new partners. Revitalizing Family Planning for Healthy Timing and Spacing of Pregnancy in the Military Health System, which was funded by the William and Flora Hewlett Foundation, contributed to the reduction of high maternal and infant mortality in Mali by promoting the use of family planning for birth spacing.
The success of this project encouraged other partners—UNFPA and the Institute of Reproductive Health of Georgetown University—to commit to expanding and continuing its activities. The US Agency for International Development (USAID) has also agreed to sustain and extend the initiative. This project illustrates how a small grant can be used to achieve results rapidly. This mechanism allows quick startup, easy management, and local organization strengthening through coaching and mentoring.
At the recommendation of the African Women’s Network for Promotion of Family Planning, Management Sciences for Health (MSH) chose the Association de Soutien au Développement des Activités de Population (ASDAP) to carry out the project. ASDAP is a local NGO created in 1982 with support from USAID. The NGO was the impetus behind a peer educator approach in Mali that has reached millions of adolescents in nine regions with messages about preventing HIV infection and unintended pregnancy. 
Advocacy The project began with a rapid participatory assessment of the major gaps and weaknesses to be addressed. Advocacy and training materials were developed and used to orient midwives, doctors, logistics specialists, and officers selected to be advocates. Advocates learned how to use a presentation that was designed to build decision-makers’ interest in and commitment to family planning as a lifesaving intervention.In meetings with program managers and high-ranking officers in the army, the advocates used data from the 2006 Demographic and Health Survey to highlight the health benefits of spacing births at least three years apart and the risks associated with short birth intervals. The presentation showed that 36-month birth intervals would eliminate 45,000 deaths in children under five. 
Capacity-Building The family planning project trained 50 service providers in contraceptive logistics, IEC, and be-havior change communication. Messages stressed proper use of the contraceptive methods avail-able in Mali and understanding of healthy timing and spacing of pregnancy. Evaluations showed a significant increase in knowledge about all items covered in the training, and the results were validated by monthly supervision reports after the training. 
Informing Clients The trainees conducted activities at all 10 military health centers to educate clients about the contraceptive methods available to them and emphasize the risks associated with short birth intervals. The midwives and nurses used the materials given to them during the training to attract new clients and retain clients who were already using family planning services. In July and August 2007, these IEC activities reached nearly 1,000 people. Accomplishments The first two months of implementation in five health centers increased the numbers of new and returning contraceptive users. Both groups doubled in the first month and were maintained at that level until technical and financial support ended. At the same time, the numbers of no-shows and dropouts dramatically decreased as a result of the education of clients about the health benefits of birth spacing. In July 2007, the five centers, which usually received few clients, recorded 60 new clients and 124 returning clients. The most-used family planning method was the pill, with 138 of 184 active users (75 percent). In August 2007, the same health centers recorded 52 more new clients and 92 returning clients. 
The project involved the military in the national initiative for repositioning family planning as an essential lifesaving intervention to reduce high infant and maternal mortality because the military health centers serve such a large population. Since they are highly respected, military authorities are also influencing civilian decision-makers to support family planning. It is clear that if the trend observed in this five-month project is maintained, the number of new and returning family planning users in Mali will continue to increase. A well-managed small grant mechanism, coupled with technical support tailored to the needs of NGOs and public institutions, appears from this experience to be an excellent approach to foster change, strengthen local institutions, and boost the delivery of reproductive health services.
Advocates highlighted the benefits of spacing births . . . 36-month birth intervals would eliminate 45,000 deaths in children under five.
By combining IEC (information, education, and communication for behavior change), advocacy using local data that highlights the health benefits of birth spacing, and support for service delivery, the project increased the use of modern contraceptives in a population of more than 290,000 served by Mali’s 10 military health centers. Of these people, 71 percent are civilians. The success of this project encouraged other partners—UNFPA and the Institute of Reproductive Health of Georgetown University—to commit to expanding and continuing its activities. The US Agency for International Development (USAID) has also agreed to sustain and extend the initiative. This project illustrates how a small grant can be used to achieve results rapidly. This mechanism allows quick startup, easy management, and local organization strengthening through coaching and mentoring.
| The Context Population growth in Mali is high, with a fertility rate of 6.6 in 2006, the highest in West Africa after Niger. Although the infant mortality rate decreased from 113 per 1,000 in 2001 to 96 per 1,000 in 2006, while the rate of maternal mortality declined from 582 to 577 per 100,000 live births, both rates are still high. The performance of the health system is poor, particularly for maternal and child health services. In 2004 only 57 percent of pregnant women received prenatal care and 41 percent were assisted at delivery by qualified providers. The Malian military health program is addressing these problems and the very low use of family planning (6.4 percent) by strengthening the health system in its target geographical areas. |
Advocacy The project began with a rapid participatory assessment of the major gaps and weaknesses to be addressed. Advocacy and training materials were developed and used to orient midwives, doctors, logistics specialists, and officers selected to be advocates. Advocates learned how to use a presentation that was designed to build decision-makers’ interest in and commitment to family planning as a lifesaving intervention. Capacity-Building The family planning project trained 50 service providers in contraceptive logistics, IEC, and be-havior change communication. Messages stressed proper use of the contraceptive methods avail-able in Mali and understanding of healthy timing and spacing of pregnancy. Evaluations showed a significant increase in knowledge about all items covered in the training, and the results were validated by monthly supervision reports after the training. Informing Clients The trainees conducted activities at all 10 military health centers to educate clients about the contraceptive methods available to them and emphasize the risks associated with short birth intervals. The midwives and nurses used the materials given to them during the training to attract new clients and retain clients who were already using family planning services. In July and August 2007, these IEC activities reached nearly 1,000 people. Accomplishments The first two months of implementation in five health centers increased the numbers of new and returning contraceptive users. Both groups doubled in the first month and were maintained at that level until technical and financial support ended. At the same time, the numbers of no-shows and dropouts dramatically decreased as a result of the education of clients about the health benefits of birth spacing. In July 2007, the five centers, which usually received few clients, recorded 60 new clients and 124 returning clients. The most-used family planning method was the pill, with 138 of 184 active users (75 percent). In August 2007, the same health centers recorded 52 more new clients and 92 returning clients. The project involved the military in the national initiative for repositioning family planning as an essential lifesaving intervention to reduce high infant and maternal mortality because the military health centers serve such a large population. Since they are highly respected, military authorities are also influencing civilian decision-makers to support family planning. It is clear that if the trend observed in this five-month project is maintained, the number of new and returning family planning users in Mali will continue to increase. A well-managed small grant mechanism, coupled with technical support tailored to the needs of NGOs and public institutions, appears from this experience to be an excellent approach to foster change, strengthen local institutions, and boost the delivery of reproductive health services.